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10-1131 (ELEC)ii" _ r P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Ta!t 4 4 Q" Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION - I hereby affirm under penalty of perjury that I a icensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a ro0`ss7oq6 Code, and my License is in full force and effect. License Class: B L ense No.: 915336 Date: � ontract WNER-BUILDER DECLARATION hereby affirm under penalty of perjury that I a exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and P essions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or . improve for the purpose of sale.). (_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: . CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/28/10 Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA, CA 92247 r � Contractor: t 8 DBCA INC 2L;� ! t P.O. BOX 1482 LA QUINTA, CA 92247 ~ `' -:,d• r.:: `':%z;r ~� / (760) 793-5271 Lic. No.: 915336 _ ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1` I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier TRAVELERS PROP Policy Number YEU13282D779708 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as t become subject to the workers' compensation laws of California, and agree that, if I should b me t to the workers' compensation provisions of Section �( 3700 of the Labor Code, I II fo hwith mply with those provisions. iDate: V • '�d plicant- WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO T COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the abov i rmaY is correct. I agree to comply with all city and county ordinances and state laws relating to building c s ctio , an reby authorize representatives of this county to enter upon the above-mentioned property for i p do rposes. �l • {b Siature (Applicant or Age � Application Number: 10---00001131= Property Address: 52865 HUMBOLDT BLVD APN: 767 -680 -012 - Application description: ELECTRICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 500 Ta!t 4 4 Q" Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION - I hereby affirm under penalty of perjury that I a icensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a ro0`ss7oq6 Code, and my License is in full force and effect. License Class: B L ense No.: 915336 Date: � ontract WNER-BUILDER DECLARATION hereby affirm under penalty of perjury that I a exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and P essions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or . improve for the purpose of sale.). (_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: . CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/28/10 Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA, CA 92247 r � Contractor: t 8 DBCA INC 2L;� ! t P.O. BOX 1482 LA QUINTA, CA 92247 ~ `' -:,d• r.:: `':%z;r ~� / (760) 793-5271 Lic. No.: 915336 _ ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1` I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier TRAVELERS PROP Policy Number YEU13282D779708 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as t become subject to the workers' compensation laws of California, and agree that, if I should b me t to the workers' compensation provisions of Section �( 3700 of the Labor Code, I II fo hwith mply with those provisions. iDate: V • '�d plicant- WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO T COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the abov i rmaY is correct. I agree to comply with all city and county ordinances and state laws relating to building c s ctio , an reby authorize representatives of this county to enter upon the above-mentioned property for i p do rposes. �l • {b Siature (Applicant or Age -Application Number. . . . . . 10-00001131' Permit . ... ELEC-TEMPORARY POWER Additional desc . Permit Fee . . . . 30.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 4/26/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 ---------------------------------------------------------------------------- Special Notes -and Comments TEMP POWER POLE FOR NEW CONSTRUCTION. 2007 CODES. -----------------_---------- Other Fees . ----------------------------------- . . . . . . BLDG STDS ADMIN (SB1473) - 1.00 Fee summary Charged Paid Credited Due ----------------- Permit Fee Total ---------- -------- 30.00 .00 .00 30.00 Plan Check Total ..00 .00 .00 .00 Other Fee Total 1.00 .00 .0.0 1.00 Grand Total 31.00 .00 .00 31.00 LQPERMIT Din # - - = CXY Of L Quints PeMJt \� �� P.O. Box I SD4, 78-495 Cage Tampko } la Qldnta, CA 92253 - (760) 777-7012 Building Pennit Application and Tracidng Sheet Prqjecc Addrm- X28 a � 52�vy �l o owttor't Namta A - P. Number: 7(07-E70-401 � QF�/S? G Conuwtoc: Y. ST, zip: [!r '111A110 a %12 7 3 09 Sz �7 iolm CD2 azo 718 Address: �� 3- -JIMM City. ST, Zip: . � l� v�iv� TelcPhonc: �� �B Pow W Sbft Lic. #: //NJ6: �QQ� 7 R. 5�j;r Lia D: r� CV '"J�ZZ7�OS Pv��t%1_ Ar&_ �� Dam; Adams ! ��ST pd 14P )WeF P OF City. ST. Zip: Tdebae. 76a •��-X707 State LtC . Name ofconbact Persm. 1 Tdephony d of Contact Ptrsoo: B 8abratthl Ptaa Sds Strudnn d Cela. Ttma Cath. Title u Cala, Flood plain plan Grading pian Subeontaetur Last Grant Deed H.O.A. Approval IN HOUSE:_ Planatng Approval Pub. Wks. Appr School Feet Rtc`d 52805 Date of permit issue Total Penult Foes Coattrugion Type: `y: — �ax type (Cmk ono): Now Add`n Ab w Rqw Dano EV/91577 sq. PL: d stories: IT Units: Zea.- -11b 3 1-*Matod Valu of Pmjeet: "ICANT: DO NOT WRITE BEWW THIS UNE i1tACKING PBB1YtIT FBES Plan Check mbmiftd Item Asionat Rerierred, ready for roe eeHoss PhaCbt& Ca&d Contact Person Plan Chedk Baling Pk= picked up Cb=tmctton Plass resnbmleted tYiechaakal 2'! Rerkrr, ready for eorredloos/iune EkebUdl Called Oontsct Person Plum Plans pickedap SJA L Plans rtsdmitted�� Review, ready for eormctloaslissae Developa Impact Fte Called Contact Puson AJXZ. Date of permit issue Total Penult Foes Pno t000.o 1 P,ao•, 79.o / /\/\ ` •� dd1 \ I ( \, \11 �E �..1Ii E Mi4D1S0j�-IJ-B l.. -i al. 46 I t r?;:'. •fr'�' 7�y.�d;rr�__.�- ^.��'�LlyBl{I�U�7E lla����'d /moi tl / / Pnm9ns / \\ � � �`` (34) i~ /, r.�\\ / :1 -•-Tq y�- /p�/; �� l\\ 1 ¢; !•_,x x;/1.1 _ / / /� \ JI 1 \ \ \�'` , 1 s l \ 1 _� 3 -___--'�1f/\/'i✓✓y4 I/j„ - 7 1 k _ _ _/ i /J' / Pao- s9.o-- FF-ee7.ao- 1-t t '` �__'� :` t� l ' i• / / / \ M1 t ,` �_-- rr} �. - �'1F' �-1....+,-fY '"•Zc"� � ifita �,/ � / � _/ . 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X1:1-.• d, ,�/, i. 0 •i N-' "EF�80, \.. •'\ - ��`` as/sn. l i a.i ..- ,I I ..-. _ 4 iC. u .i .,h,;� w.;r;., ;. \,, , f/ • :� ♦`�, - `��.C'%��.. ,p. .r.�„ •r ;yu. : \_.���-s' •Jr . tr ` '•�, �'�� 1 , 'hsF=99o.0 r .: ' 1t yy�s�xrs�, - - _ ._ - _-= __ _ % -•��^_ .:c`sys %I ! - - � ,\ % r is � ,- , �_ 'i'-- - , _-._-.-�_ -__ "�\`�,�_.._ i -�-:%iii �i%/i_ •'' _ \ '��t114 9885) +' -HUMBOLDT_53 ' GRAPHIC SCALE • 1 i / 7595 W- ca- 0, CITY OF LA QUINTA DRAWING NAME: IrNna 9.4926111 1.�' FO ItFA_l1p32 THE MADISON CLUB uc EH -0H -VILLAS Pa00e: 949.450111 MLI i � Fse9.455.oanD PROJECT No. Consultants Inc. �%F g v Q~ CLUBHOUSE AND VILLAS EXHIBIT o001 MDC SCALE: FILE No. DATE 111 SHEET 1 OF 1 1' = 50' 0502 01/02/08 i